Acute weight loss vs. Chronic weight management -by Ethan Lazarus, MD

Do you ever feel like every year your New Year’s Resolution is to lose weight, yet by the end of the year you are back where you started?

If so, you are not alone. Although obesity has been recognized as a serious, chronic disease, there is still a focus on acute weight loss instead of chronic weight management. In fact, most individuals focus on weight loss as the main endpoint, instead of recognizing the more important outcomes of improving health and improving quality of life.

Interestingly, when it comes to medications for weight management, there is a huge problem that medications are discontinued. People understand that medications for other chronic diseases like high blood pressure or diabetes are used long-term. But people assume that medications for weight loss can be used while weight is being lost, then discontinued. In fact, often we hear our patients say that their medication is not working because the weight is not continuing to go down. If we start a blood pressure medication and the blood pressure drops 5% or 10% then stabilizes at a lower number, we would say the blood pressure medication worked well. Similarly, when it comes to weight management, if a person successfully drops at least 5% to 10% of their body weight, we would say that the medication is working, even if the individual hasn’t lost quite as much weight as they would like.

The other interesting statistic that we see is that there is a huge uptick in medication use in the first quarter of the year, and then a large drop in prescription use in the second half of the year, suggesting that people are ready to engage in acute weight loss after New Year’s Eve, but not willing to commit to chronic weight management. This would be like treating diabetes or hypertension aggressively for a few months, then taking the rest of the year off. This would be unlikely to alter disease course for these diseases, and leave individuals at high risk for heart attacks and other unfortunate outcomes.

Let’s treat weight problems seriously, like these other diseases. Let’s commit to chronic weight management and not focus on acute weight loss. Let’s focus on treatment strategies that work – office visits, medications, meal replacements, increased time devoted to physical activity, stress reduction and improving sleep patterns. Let’s shoot for improvements in quality of life and health as outcomes rather than just focusing on amount of weight loss. Let’s move away from language like “weight loss” and “maintenance” and instead use words like “treatment.”

And, for next year, let’s have a new New Year’s resolution: to stay healthy and enjoy an improved quality of life.

This would be for medications approved for weight management. This includes: phentermine, tenuate, Contrave, Belviq, Qsymia and Saxenda. Other medications are sometimes used to maintain weight loss like metformin and wellbutrin. Or, sometimes I can adjust other medications one is on that may contribute weight gain for others that are weight neutral.